Schools and Health Our Nation's Investment (1997) / Chapter Skim
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5 Building the Infrastructure for Comprehensive School Health Programs
5 Building the Infrastructure for Comprehensive School Health Programs
Pages 237-270
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From page 237... ...
The order of the infrastructure discussion reflects the order of potential impact; the national infrastructure establishes various policies, programs, and funding streams that have an effect on and provide the framework for states, which, in turn, coordinate policies, programs, and funding streams that impact on the local level. The committee is certainly aware that in the current policy environment, there is an emphasis on minimizing the federal role and on devolving, or transferring, decisionmaking regarding education and other social programs to the state and local levels.
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From page 238... ...
· To help children meet these challenges, education and health must be linked in partnership. · School health programs support the education process, integrate services for disadvantaged and disabled children, and improve children's prospects.
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From page 239... ...
Federal agencies, through the leadership of the ICSH, could help promote awareness and adoption of national standards in health education, physical education, school nutrition, school nursing, and school-based health care.1 Grantees of federal programs for school health should be expected to give attention to these standards, and funded projects should be aligned with the concept of a comprehensive program. The position of health education in the K-12 curriculum is ambiguous, because health education is not one of the core subjects specified in the National Education Goals (although it is mentioned in the context of Goal 7 on safe, disciplined, and alcohol- and drug-free schools)
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From page 240... ...
National Coordinating Committee on School Health The National Coordinating Committee on School Health brings together federal departments with approximately 40 national nongovernmental organizations to support quality comprehensive school health programs in the nation's schools. The NCCSH is staffed by the same office as ICSH, and the committees work closely with each other.
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From page 241... ...
The committee suggests that the NCCSH should be considered the official advisory council to the ICSH and that participating NCCSH organizations should mobilize their memberships to promote the development of the comprehensive school health infrastructure at the state and local levels. The committee feels that the NCCSH currently may be limited in its influence because managed care, indemnity insurance providers, and others key to resolving critical financial issues seem to be missing from its membership; the committee suggests that the NCCSH might be strengthened by actively soliciting the participation of those with financial interests in CSHPs.
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From page 242... ...
has funded 12 states and the District of Columbia to develop their own infrastructure to strengthen comprehensive school health programs and student educational achievement.3 The goal of this initiative is not only to build programs and increase understanding about the process but also to have states serve as models for and provide technical assistance to other states. In each of these states, funding has been provided to hire a senior staff member in the state department of education and department of health and human services in order to ensure program coordination between these agencies and efficient utilization of health and education resources.
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From page 243... ...
can reimburse schools for screenings, These resource centers include the National center for Education in Maternal and Child Health at Georgetown university, which maintains an extensive database on maternal and child health projects and resources; National center for Leadership Enhancement of Adolescent Programs at the Colorado Department of Public Health and Environment; National Adolescent Health Information center at the university of California, san Francisco; Child and Adolescent Health Policy center at George Washington university; National Schoolsased Oral Health/Dental Sealant Resource center at the university of Illinois at Chicago; Child and Adolescent Health Policy center at Johns Hopkins university; School Health Resource services at the university of Colorado Health services center; National Adolescent Health Resource center at the university of Minnesota; and the School Mental Health centers at the university of California at Los Angeles and the university of Maryland at Baltimore.
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From page 244... ...
These curricula are then introduced to state and local DASH grantees and to members of an already established network of state level teacher training centers, which in turn introduce the materials to school districts for their consideration. CDC, national organizations, and curriculum developers arrange for the training of "master teachers" and provide technical assistance to state and local education agencies in implementing curricula.
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From page 245... ...
The reports covered in the review, as well as the review itself, provide a wealth of information on comprehensive school health programs. Examples of report publishers include the American Association of School Administrators, American Medical Association, Carnegie Council on Adolescent Development, Children's Defense Fund, Council of Chief State School Officers, National Association of State Boards of Education, National Commission on Children, and the National School Boards Associa
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From page 246... ...
convened a conference in Tune 1992 (ACS, 1993) to develop a "National Action Plan for Comprehensive School Health Education" and provided support for the production and dissemination of the National Health Education Standards in 1995 (joint Committee on National Health Education Standards, 1995~.
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From page 247... ...
, in all but two states health education program staff have conducted joint activities or projects with staff from other components of the school health program (Collins et al., 1995~. Similar interagency collaborative activities were also conducted by 86 percent of state school health services programs (Small et al., 1995)
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From page 248... ...
Examples of federal funding streams arriving at state education agencies and their possible uses for school health include the following: · Funds for AIDS/HIV prevention education from CDC/DASH can be used to improve health education in the classroom by training teachers and to improve health services by training school nurses to care for students who may be HIV infected. Funds can also be used for improvement of the school environment and for policy development.
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From page 250... ...
A1though these funds may not be specifically targeted to schools, some might logically be used for CSHPs, including the following: · Chronic Disease and Health Promotion funds from the CDC for tobacco prevention, promotion of physical activity, and diabetes prevention, can be used for training teachers who deliver focused health education dealing with these topics. CDC funding for HIV/AIDS prevention can often be used by schools for classroom programs.
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From page 251... ...
The committee suggests that a state technical assistance network a "school health extension service" modeled after the Agricultural Extension Service could be an effective mechanism for conveying assistance from the state level through the regional level to the local level.5 Regional educational service agencies, Boards of Cooperative Educational Services (BOCES) , county extension services, area health education centers, and other regional health and/or education service agencies could be linked in a manner similar to that used in the state school health coordinating council; this would provide a regional focal point for school health that 5USDA,s Extension Service a national cooperative effort by federal, state, and local governments was established in 1914 to bring new agricultural information and technologies from government and university laboratories to the local farmer.
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From page 252... ...
According to SHPPS (Collins et al., 1995) , only one-third of all districts have a "district-wide school health advisory council that addresses policies and programs related to health education." Further, the roles and extent of influence and responsibilities of these councils are not clear.
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From page 253... ...
In its report on comprehensive school health programs, the National School Boards Association highlighted the programs of approximately 25 exemplary districts all of which had in common the designation of a central person as program coordinator. This coordinator devoted from 10 to 100 percent of his or her time to this task; according to the study, the important factor was not so much the amount of time spent as the interest and organizational abilities of the individual (Penfield and Shannon, 1991~.
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From page 254... ...
Existing resources can be maximized by considering schools as an essential, integral part of the overall community health and service system. Although school health programs are often called "comprehensive," it should be emphasized that programs and services actually delivered at the school site may not provide complete coverage by themselves.
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From page 255... ...
· Interdisciplinary team members communicate interventions and new techniques developed by the interdisciplinary work team to professional colleagues in their discipline. The work groups/teams might focus on the following issues: Work Group A: Promoting cardiovascular health Work Group B: Reducing substance abuse Work Group C: Improving health services Work Group D: Reducing violence The Professional groups might have the following composition: Professional Group 1: School administrators Professional Group 2: School nurses Professional Group 3: Health teachers Professional Group 4: Guidance counselors Professional Group 5: Physical education teachers Professional Group 6: Psychologists Professional Group 7: Science teachers FIGURE 5-1 Interdisciplinary teams within the school.
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From page 256... ...
Students receiving special attention at school may also be undergoing assessment and treatment in health and social services systems outside the school; they may be seen and/or treated by psychologists, psychometrists, social workers, counselors, nurse practitioners, physicians, physical therapists, occupational therapists, adaptive physical education specialists, speech pathologists, case managers, and so on. School and community professionals may or may not have similar professional credentials and licensure; assessments may be varied or duplicated; and interventions may occur in both settings or neither setting.
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From page 257... ...
Thus, supporters of comprehensive school health programs must become activists at school board meetings and in the media although they
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From page 258... ...
Supporters can also be armed with facts such as the results of the national Gallup and Harris surveys, discussed in Chapter 3, which show overwhelming support for school health education from parents and students. They can cite studies of parents' perceptions of school-based health centers, such as the one carried out in the vicinity of Portland, Oregon, which found that parents overwhelmingly favored the provision of all general health, counseling, parent education, and reproductive health services in the school (Glick et al., 1995~.6 Healthy Caring, the process evaluation of the Robert Wood Johnson School-Based Adolescent Health Care Program, found that controversy surrounded the start-up of school-based health centers at almost all program sites (Marks and Marzke, 1993~.
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From page 259... ...
The school's mission is to ensure that its graduates have the skills and qualities that are needed to succeed in the world of work, and a comprehensive school health program can play a central role in meeting this goal. Therefore, an important task of the community coordinating council is to help the community come to see the school health program as a critical and primary compo
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From page 260... ...
No matter how high the quality of the school program, its effects will likely be diminished if the community environment does not support and reinforce the program. A strong community coordinating council can work to ensure that all health messages received in the school are reinforced in the community.
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A set of principles for integrating local education, health, and human services for children, youth, and families was affirmed by the more than 50 national organizations that met at the consensus conference in lanuary 1994 (American Academy of Pediatrics, 1994~. The conference report, Principles to Link By, outlines eight principles for building stronger structures for coordination in the development of the CSHP infrastructure: 1.
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From page 262... ...
Specifically, the ICSH and the NCCSH should develop a national action plan for school health and, in so doing, promote the adoption of the national standards in health education, physical education, school nutrition, school nursing, and school-based health care. To provide leadership in research, the ICSH and NCCSH could establish a grants program for basic research and outcome evaluation in school health programming; ensure that national data about student health behaviors and health status as well as school health programs and practices are collected, monitored, and tracked; encourage the inclusion of health topics in national and state assessment programs, develop national and state "school health report cards," and establish a national clearinghouse,
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From page 263... ...
The committee recommends that an official state interagency coordinating council for school health be established in each state to integrate health education, physical education, health services, physical and social environment policies and practices, mental health, and other related efforts for children and families. Further, an advisory committee of representatives from relevant public and private sector agencies, including representatives from managed care organizations and indemnity insurers, should be added.
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From page 264... ...
Among its duties, the district coordinating council should appoint a district school health coordinator to oversee the program; involve the community in conducting a needs and resource assessment; develop plans and policies for delivery and ongoing assessment of quality programs (with special attention to students at greater risk) ; provide information to individual schools about standards, practice, and technological developments; coordinate programs and resources; increase cross-agency integration of funding streams and research; assist each individual school in designating a school health coordinator and a school health committee; coordinate school health and social service programs with other community programs and resources, including the private health care sector; ensure that all students have a medical home a stable, accessible source of primary care; collaborate with nearby districts, regional, or state providers of technical assistance, information, and inservice programs; support the employment, involvement, and continuing professional development of appropriately prepared professional school health staff; and 7A "community" may consist of a single school district or be divided into two or more districts.
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From page 265... ...
; appoint representatives to the district school health coordinating council; coordinate activities and resources with the district coordinating council for assessment of students' needs and behaviors; coordinate funding, time, space, personnel, and other resources to implement comprehensive school health education and provide needed health services for students at the school or at school-linked sites; coordinate case management of services for students at risk; support the employment, involvement, and continuing professional development of appropriately prepared professional school health staff; and seek the active involvement of students and families in designing and implementing programs. The comprehensive school health infrastructure the basic interconnected framework on which programs can be built is summarized in Figure 5-2.
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From page 266... ...
Reprinted with permission. American School Health Association, Kent, OH.
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From page 267... ...
from one setting to another in order to respond to changing health delivery demands, · designation of a school health coordinator at each school site, with appropriate released time or compensation, · employment of professionally prepared foodservice or nutrition directors and managers, · increased emphasis on interdisciplinary health-related experiences in the preservice preparation of all educators and school personnel, · additional and ongoing training of school health professionals, especially in the ability to translate and adapt research findings to field practice, · increased health-related knowledge of individuals in disciplines outside health education so that they are better able to see the relationships between their own disciplines and health promotion, · increased emphasis on school health in pediatric and family practice training for physicians, including the roles of physicians in primary and specialty care, as well as roles for physicians from academic health centers and hospitals, in these programs, · possible creation of a new category of personnel comprehensive school health coordinators who can work with both the school and the community and who have the management skills to operate complex partnership programs. The call for proper professional preparation is not intended to be selfserving or to promote narrow professional interests; instead, the committee believes that CSHPs and the health of our children are important enough to merit a requirement for well-prepared, qualified professionals.
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From page 268... ...
1993. National action plan for comprehensive school health education.
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Washington, D.C.: National School Health Education Coalition. Thomas, C.F., English, J.L., and Bickel, A.S.
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From page 270... ...
1993. Peer coaching: Building collegial support for using innovative health programs.
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